Vol.8 No.37 www.cdc.go.kr ISSN:2005-811X PUBLIC HEALTH WEEKLY REPORT, PHWR CONTENTS 0870 신변종바이러스확인진단에서세포배양의중요성과의의 0876 2014 년감염병감시체계운영결과 0886 해외여행후 Plesiomonas shigelloides 감염에의한설사환자발생사례보고 0889 주요통계 : 수족구병의사환자분율 / 유행성각결막염, 급성출혈성결막염발생분율 / 인플루엔자의사환자분율 / 지정감염병
주간건강과질병 제 8 권제 37 호 신변종바이러스확인진단에서세포배양의중요성과의의 Significance of Viral Culture Technology in Novel Viral s Diagnosis Abstract BACKGROUND: Cases of emerging and re-emerging infectious diseases have increased due to various factors such as climate change, environmental pollution, and globalization. Rapid identification of the causative agents of unknown pathogens is crucial in preventing these diseases from becoming a widespread risk to public health. Thus, it is critical to evaluate the implementation of rapid identification systems that include the recently developing application of molecular methodology to the discovery of novel pathogens in instances of unknown infectious illnesses and worldwide epidemics. CONCLUSIONS: Although molecular diagnostic techniques including high-throughput sequencing are being developed in various scopes and magnitudes, it is critical to retain and develop classical techniques such as virus isolation, electron microscopy and serological diagnosis. Among these classical methods, virus isolation in particular supports other diagnostic methods through the increase of virus titers that directly prove the presence of a novel pathogen. In addition, virus isolation will help in the development and verification of diagnostic tools, anti-viral drugs and vaccines. The combination of cell culture, electron microscopy, serological and genetic methods (including metagenomic analysis) is an unbiased approach to the identification of unrecognized pathogens. Collaboration among clinicians, epidemiologists, microbiologists, electron microscopists, and laboratorians who use different technologies is also critical for the successful investigation of unknown diseases. 질병관리본부국립보건연구원감염병센터호흡기바이러스과 김유진, 이한샘, 김성순 1) 들어가는말 현재보건의료기술이발전하면서다수의감염병에대한백신제제와치료제들이개발되고있다. 그럼에도불구하고, 지구온난화등기후및환경의변화, 생활환경및행동의변화, 미생물의진화특성으로인해인수공통감염병의발생이증가하고있고, 사스 (severe acute respiratory syndrome : SARS), 조류인플루엔자, 에볼라바이러스병같은신변종감염병이국제적으로출현하고있으며, 앞으로도지속적으로출현할것으로예상된다 [1](Figure 1, Table 1). 뿐만아니라, 국가간교역과세계여행의증가로인해우리나라에서 발생하지않던해외감염병들이국내로유입될가능성또한증가하였다. 실제로해외에서발생했던웨스트나일열, 라임병, 치쿤구니아열등의국내유입이보고되는등감염병발생양상에변화가일어나고있다 [2]. 최근의감염병발생의특성은특정지역에국한하여일시적으로발생하기보다는여러지역에걸쳐수시로발생하고, 확산속도가빠르다는점이다. 따라서신변종에의한원인불명감염병발생시, 사회적혼란및국가적재난으로커질우려가있다. 공기를통한바이러스감염의경우초기대응이중요하며, 초기대응에실패하면국가적위기상황이발생될수있어, 감염병관리체계강화및지속적인대응연구가필요하다. 특히, 1) 교신저자 (sungskim@korea.kr, 043-719-8220) 870 www.cdc.go.kr
PUBLIC HEALTH WEEKLY REPORT, KCDC Figure 1. Novel or re-emerging infectious diseases worldwide from 1990 to 2006[3]. 기존진단체계로판정할수없는원인불명의신변종감염병이발생하였을때, 이후확산방지와재발생시진단을위해필수적으로원인병원체를규명하는연구가진행되어야한다. 그러므로해외에서발생한신변종및재출현바이러스발생에대한관심과모니터링이전적으로필요하며, 전염확산이빠른 긴급한상황인경우, 국가예방대책차원에서정확하고빠른진단과신속한대처가중요한역할을한다. 이글에서는바이러스진단분야의최첨단기술이개발되고발전해나가는상황에서세포배양을통한바이러스분리배양법의현황, 중요성과의의를기술하고자한다. Table 1. Novel viruses identified in human for recent 20 years Year Viruses 1994 Hendra virus 1995 Australian bat Lyssa virus 1997 Influenza A/H5N1 virus 1999 Nipah virus 2001 Human metapneumovirus 2002 Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) 2004 Human coronavirus NL63 2005 Human coronavirus HKU1 2005 Human bocavirus 2009 2009 pandemic influenza virus 2009 Severe fever with thrombocytopenia syndrome virus (SFTS virus) 2009 Cedar virus 2012 Middle east respiratory syndrome coronavirus (MERS-CoV) 2013 Influenza A/H7N9 virus www.cdc.go.kr 871
주간건강과질병 제 8 권제 37 호 몸말 바이러스규명연구에서그동안은세포배양기술을이용한바이러스분리와전자현미경을통한형태학적분류, 컨센서스중합효소연쇄반응 (Consensus PCR), SISPA(Sequenceindependent single primer amplification) 방법, 혈청학적분석등이사용되어왔다. 최근에는 Roche 454, Illumina와같은플랫폼을기반으로하는대용량시퀀싱 (High-throughput sequencing, HTS) 기술과임의적증폭 (arbitrary amplification) 기술을활용하여여러가지감염병을진단하는방법을개발하거나개선하는노력이여러그룹에서지속적으로이루어지고있다 (Figure 2). 또한, VIDISCA (Virus Discovery based on cdna Amplified Fragment Length Polymorphism)-454, Pathoscope, MetaVir, VirusHunter, VirusFinder와같은다양한방법과웹기반의분석서비스, 분석파이프라인개발에가속도가붙고있는실정이다. 우리나라의경우, 차세대염기서열분석 (Next generation sequencing, NGS) 기술수준은매우높은편이지만진단분야에대한활용기술은아직실용화단계로도입하지못하였으며, 임상검체들을대상으로소수의연구그룹에서메타지노믹스연구, 진단실패검체에대한원인규명연구를진행하고있는상황이다. 미국질병관리본부 (CDC), 독일로버트코흐연구소 (Robert Koch Institute), 네덜란드에라스무스대학 (Erasmus University) 등해외에서는원인불명의감염병원인규명을위해전자현미경관찰과세포배양을포함한기존기술들부터최신 NGS 분석기술들을체계적으로모아신변종의감염병발생에대비하고있다 [5]. 실제이런체계를통해사스 (SARS), 중동호흡기증후군 (Middle east respiratory syndrome, MERS) 같은신종감염병을규명한사례들이있다 (Table 2). 최신 HTS 기술로인해특이적인표적을정할필요가없이신속하게대용량의세균및바이러스의유전자정보를확보하고, 분석할수있게되었다. 그러나 HTS 기술에기반한원인바이러스진단연구는바이러스종에따라차이는있으나아직은검출한계 (detection limit) 가높다는점과감염증을유발하지않는정상세균총 (normal flora) 에대한배제가어렵다는제한점이있다. 최근까지도세포배양을통해세포병변효과 (cytopathic effect, CPE) 가확인된경우와검체의농축이가능한대변 (stool) 과같은시료에서는 NGS 유전자분석기술로성공적인결과가나오지만, Figure 2. Advanced genetic analysis platform for identification of novel pathogen[4]. 호흡기바이러스의경우에는소량의검체로진단하므로 NGS 연구가더디게진행되고있다. 872 www.cdc.go.kr
PUBLIC HEALTH WEEKLY REPORT, KCDC Table 2. Protocols used for identification of the s of unknown infectious diseases Year Virus Method 2001 Human metapneumovirus Cell culture Electron microscopy Anti-serum production RAP-PCR 2002 SARS-CoV (Severe acute respiratory syndrome coronavirus) Cell culture Electron microscopy Pan-corona PCR Immunofluorescence assay 2005 Human bocavirus Pre-treatment for removing host genome and concentration Random PCR 2012 MERS-CoV (Middle east respiratory syndrome coronavirus) Cell culture Pan-corona PCR Whole genome sequencing using NGS 유전자분석을통해신종병원체를검출할수있어도코흐의공리 (Koch's Postulates) 에따라질병의원인을명확히검증할필요가있다. 또한, 새로운감염병에대한분자생물학적연구, 항체와같은치료제, 백신, 진단제의개발및평가를위해서는세포배양을통한바이러스분리가필수적이다. 최근발견된 SARS, MERS와같은신종코로나바이러스, 메타뉴모바이러스와같은호흡기바이러스도세포배양을통해먼저바이러스가분리되었고, 분리된바이러스를대상으로유전자분석을수행함으로써동정및확인되었다 [6](Table 2). 전통적인분리배양은일반적으로불멸화된세포주나동물에감염시키는방법이주로사용되는데, 바이러스의종류나수용체의감수성에따라일반적인세포주나동물모델에서배양이잘되지않는난배양성바이러스가배양이잘되는바이러스보다매우많다. 또한바이러스의배양에소모되는노동력과시간투자도유전자검사나다른진단방법에비해많다. 하지만, 최근에는세포배양기술의발달로배양에소모되는시간을줄여줄수있고바이러스에대한감수성을넓히기위한방법이시도되고있다 [7,8](Table 3). 쉘바이알 (Shell vial) 배양을통한바이러스증식법의경우, Table 3. Development of cell culture techniques[7] Type Features Cost/average turnaround time Traditional tubes Shell vials with centrifugation/pre- CPE stain Co-cultivated cells Transgenic cells Polarizaton/ Differentiation Isolate wide variety of viruses Technological expertise needed to read CPE Short around time for detection Not as sensitive as traditional cultures When pre-cpe staining targets were determined, unanticipated agents may be missed and isolates not available from fixed/stained vials Decreased need for maintaining wide variety of cell cultures, support growth of a wider range of viruses Targeted for detection of only single or few virus group Increased isolation rates Technical expertise and long time needed to differentiate cells preparation 1.50-4.00$ per tube for nonprimary cells 2.15-6.15$ per tube for primary cells 5-10 days Same as comparable cell culture 24-48 h 1.25$ more per vial than standard shell vials 24-48 h 2.35-3.00$ more per vial than standard shell vials 24-48 h www.cdc.go.kr 873
주간건강과질병 제 8 권제 37 호 세포를쉘바이알안에서배양하고, 바이러스감염시손쉽게원심분리를통해물리적으로바이러스와세포간의감염효율을높여주게된다. 이방법을적용하면거대세포바이러스 (cytomegalovirus) 등과같이배양을위해 14-21 일정도걸리던바이러스를 2-3 일안에빠르게증식시킬수있다. 일반적으로한종류의세포주로바이러스를배양하고분리하지만바이러스수용체 (receptor) 가세포내한종류가아니라여러종류인경우, 2-3가지다른세포주를혼합배양함으로써바이러스에대한민감도를높이는방법도있다. 그러나여전히불멸화된일반세포주들안에서증식이안되는바이러스들도상당수있고, 실제조직이나검체에서채취한바이러스인경우, 실험실에적응된일반세포주에서증식이억제되기도한다. 그러므로일반세포주에서의바이러스분리법에대한단점들을극복하고자사람조직과비슷하게분화시킨유사조직을이용한분리방법도주목할만하다 [9]. 난배양호흡기 세포에감염이되더라도세포내증식을방해하는인터페론 (interferon) 과인터페론수용체의발현으로바이러스증식이억제되기도한다. 인터페론발현을감소시키는화학물을처리함으로써바이러스증식효율을향상시킨사례가있다. 이방법도바이러스증식률을높이고, 원인불명바이러스나난배양바이러스를분리하는데적용될수있다. 바이러스의수용체는매우다양하여세포주에대한감수성범위가매우좁긴하지만, 특정수용체를발현하는재조합세포주 (transgenic cell) 를보유하는경우는유사종의임상분리주의확보및바이러스의변이연구에유용할것으로사료된다. 유전자분석기술의발달로전통적인병원체배양성공후원인규명순서와달리최근에는원인병원체추정이후유전학적재조합기술을이용한배양시스템구축, 감염동물모델개발의순서를따르기도한다. 바이러스의경우, 사람호흡기기도조직과유사하게분화시킨 기도다열상층상피조직 (well- differentiated pseudostratified airway epithelium) 을이용하기도한다. 분화된기도다열상층상피조직은직접사람의기도상피조직에서분리한세포 (human airway epithelial cell, HAE) 를공기 -배양액접점에서배양및분화시켜형성한것으로, 이분화된 HAE는실제사람의기도처럼섬모 (cillia) 구조및점액 (mucin) 분비의기능을갖추고있기에독성실험, 천식모델, 낭포성섬유증 (cystic fibrosis) 질환모델, 약효능실험등에주로이용되고있다. 최근분화된 HAE로부터세포주에서배양하기힘든사람보카바이러스, 사람코로나바이러스 HKU1, 라이노바이로스 C를배양하는데성공하였고, 그외일반적인호흡기바이러스들 ( 인플루엔자바이러스 A, 파라인플루엔자바이러스, 호흡기융합세포바이러스, 아데노바이러스, 사스중증코로나바이러스 ) 의증식및배양도보고되었다. 원인불명의호흡기바이러스병원체를분리하거나난배양호흡기바이러스분리를위하여분화된 HAE가유용할것이다. 그외에단핵구 (monocyte) 나대식세포 (macrophage), 수지상세포 (dendritic cell) 와같은면역세포를감염시키는바이러스의경우사람말초혈액단핵세포 (peripheral blood mononuclear cell) 를이용하여바이러스배양및분리할수있다. 바이러스가 맺는말 2014년서아프리카에서에볼라바이러스병재출현으로인해우리나라에서도신변종감염병대응에대한관심이급격히높아졌고, 현재질병관리본부에서는신변종등감염병위기대응연구를중점과제로선정하여효율적으로대응하기위한감시, 조기탐지, 원인규명, 전파차단, 확산방지를위한연구를수행하고있다. 신속한신변종감염병대응을위해서는 NGS 방법등의유전자분석법과더불어바이러스분리, 확인동정에필요한바이러스세포배양법을최적화, 고도화하는연구개발이반드시필요하다. 이런연구를통해원인불명의감염병발생시향상된바이러스배양능력을바탕으로바이러스자원을용이하게확보할수있게되고, 명확한원인병원체를제시함으로써감염병대응능력향상에기여할것으로기대된다. 또한산업계, 의료계, 학계에서의병인론연구, 진단제, 치료제및백신개발에필수적인자원을제공함으로써, 감염병차단을위한효율적인전략수립이신속히이루어져사회동요및국민불안을최소화할것으로예상된다. 874 www.cdc.go.kr
PUBLIC HEALTH WEEKLY REPORT, KCDC 참고문헌 1. Morse SS. 1995. Factors in the emergence of infectious diseases. Emerg Infect Dis. 1(1):7-15. 2. 질병관리본부, 년감염병관리사업지침 3. Gayer M, et al. 2007. Conflict and emerging infectious diseases. Emerg Infect Dis. 13(11):1625-1631. 4. Chiu CY. 2013. Viral pathogen discovery. Curr Opin Microbiol. 16(4):468-478. 5. 이한샘, 이준우, 2014. 주간건강과질병제 7권제35호 :767-772. 6. Goldsmith CS, et al. 2013. Cell culture and electron microscopy for identifying viruses in diseases of unknown cause. Emerg Infect Dis. 19(6):886-891. 7. Leland DS and Ginocchio CC. 2007. Role of cell culture for virus detection in the age of technology. Clin Microbiol Rev. 20(1):49-78. 8. Hodinka RL. 2013. Point: is the era of viral culture over in the clinical microbiology laboratory. J Clin Microbiol. 51(1):2-4 9. Farsani SM, et al.. Culturing of respiratory viruses in well-differentiated pseudostratified human airway epithelium as a tool to detect unknown viruses. Influenza Other Respir Viruses. 9(1):51-57. www.cdc.go.kr 875
주간건강과질병 제 8 권제 37 호 2014 년감염병감시체계운영결과 The Results of the National Infectious s Surveillance, 2014 Abstract The Korea Centers for Control and Prevention (Korea CDC) publishes annually the previous year's surveillance report on infectious diseases. Data reported by the National Infectious Surveillance System (NIDS) are useful for detecting outbreak, analyzing disease trends and making projections. The data concerning nationwide infectious diseases were collected and aggregated through the implementation of the Communicable Control and Prevention Act. About 78 Infectious diseases (115 sub-classifications) are classified into six groups. In 2014, the reported s of infectious diseases increased by 14.0% - from 112,842 s in 2013 to 128,678 s in 2014; the rate increased from 221 (2013) to 251 (2014) per 100,000 population. In 2014, the top five reported s of infectious diseases were Varicella (34.5%), Tuberculosis (27.1%), Mumps (19.7%), Scrub typhus (6.3%), Scarlet fever (4.5%), and other diseases (8%). The top five infectious diseases accounted for over 92% of the total reported s of infectious diseases. For Class Ⅰ infectious diseases, the rate of classical water-borne diseases decreased due to improved sanitary conditions; however, there was an increase in the infections due to an outbreak in several communities. In the of Class Ⅱ infectious diseases, the occurrence of Mumps, Pertussis, and Varicella continued because of low booster immunization rate and waning immunity, whereas most VPDs were eliminated. Moreover, there was an outbreak of Measles infections caused by imported s that occurred in communities and hospitals. For Class Ⅲ infectious diseases, Malaria decreased due to the implementation of active malaria control programs. But in 2014, both local and foreign disease transmissions slightly increased. In of Class Ⅳ diseases, the Dengue fever s has steadily increased. However in 2014, the imported s decreased slightly because of the corresponding decline in the travelers/visitors from South East Asian countries. The major imported infectious diseases that occurred in 2014 were Dengue fever (41%), Malaria (20%), Shigellosis (10%), Typhoid fever (6%), Hepatitis A (5%), and Measles (5%). Most s were endemic in Asian countries (85%) such as the Philippines, Indonesia, Vietnam, India and China. Other diseases came from African countries (11%) such as Ghana and Equatorial Guinea. 질병관리본부감염병관리센터감염병감시과 조승희, 박숙경, 성연희, 이은경, 조은희 1) 1) 교신저자 (enhi210@hanmail.net, 043-719-7160) 876 www.cdc.go.kr
PUBLIC HEALTH WEEKLY REPORT, KCDC 들어가는말 감염병은병원체, 또는병원소로부터감수성이있는인체에침입하여감염및질병을일으키는상태로, 이러한감염병의전파는개인뿐만아니라사회전체에영향을미칠수있다. 이런감염병을효과적으로예방및관리를위해서는신속하게대상질병의크기와발생추이를파악하고분석하여야하므로, 공중보건학적으로관리되어야할필요가있는감염병을 보건소에신고하도록하는 표본감시체계 (Sentinel Surveillance System), 이외특정감염병발생현황및추이를파악하고법정감염병감시체계의미비점을보완하는학교감염병감시체계, 안과감염병감시체계등보완적감시체계로나뉜다. 본글에서는감염병웹신고시스템 (National Infectious s Surveillance System) 을통해 2014 년도에신고된자료들을중심으로법정감염병의발생현황과추세를살펴보았다. 국가마다법으로규정하여감시 조사 관리하고있다. 우리나라는 1954년 전염병예방법 을제정하면서전염병감시체계를운영하기시작하였고, 2000년전면개정되어공포된 전염병예방법 에따라전염병의종류및분류를재편하여방역목적에맞게분류하였다. 2010년에는기존 전염병예방법 을 감염병의예방및관리에관한법률 로전면개정 시행하여법정감염병의종류및분류를크게확대 재편하였다. 2014 년에는제2군감염병에폐렴구균이신설되어 6개군 78종으로분류 ( 세분류 115종 ) 되었으며, 법정감염병의발생자료는법률에따라감염병환자를진단한의료인 ( 의사, 한의사등 ) 이보건기관에신고한자료를기초로하고있다. 법률에의한법정감염병의분류기준은마시는물또는식품을매개로발생하고, 집단발생의우려가커서발생또는유행즉시방역대책이수립되어야하는제1군감염병, 예방접종을통하여예방및관리가가능하여국가예방접종사업의대상이되는제2군감염병, 간헐적으로유행할가능성이있어계속그발생을감시하고방역대책의수립이필요한제3군감염병, 국내에서새롭게발생하였거나발생할우려가있는감염병또는국내유입이우려되는해외유행감염병인제4군감염병, 기생충에의해감염되어발생하는제5군감염병, 그외의감염병유행여부를조사하기위하여감시활동이필요한지정감염병으로나뉜다. 감염병감시체계는감염병발생시의무적으로지체없이관할보건소에신고하도록하는 전수감시체계 (Infectious disease Surveillance System), 일정한기준에의해참여하는의료기관을표본감시기관으로지정하여 7일이내에관할 몸말 2014 년도감염병신고환자수는총 128,678 명 ( 인구 10만명당 251명 ) 으로 2013년 112,842명 ( 인구 10만명당 221명 ) 에대비 15,836 명 (14.0%) 이증가한것으로나타났다 (Figure 1). 지난해보다증가한주요감염병은제1군감염병중장티푸스, 장출혈성대장균감염증, A형간염, 제2군감염병중백일해, 홍역, 유행성이하선염, 수두, 제3군감염병중말라리아, 성홍열, 제4군감염병중중증열성혈소판감소증후군등이었고, 감소한주요감염병은제1군감염병중세균성이질, 제2군감염병중풍진, 제3군감염병중쯔쯔가무시증, 신증후군출혈열, 제4군감염병중뎅기열등이었다. 2014년도감염병환자발생규모는수두가 44,450명 ( 총신고건수의 34.5%) 으로가장많았고, 이어결핵 34,869명 (27.1%), 유행성이하선염 25,286 명 (19.7%), 쯔쯔가무시증 8,130 명 (6.3%), 성홍열 5,809 명 (4.5%) 순으로다발순위 1-5 위를차지하였다. 이들 5종의감염병은 2014년도전체감염병발생건수의 92.1% (118,544 명 ) 의비중을차지하였다 (Figure 2). 연령별감염병발생순위를보면 (Table 1), 위의다발 5종감염병은대부분의연령층에서높은순위를차지하였다. 연령군별로가장많이발생한감염병은 0-9세에서는수두, 10-19세에서는유행성이하선염이었고, 20세이상에서는모두결핵이 1위를차지하였다. 40대이상에서는 1위결핵, 2위쯔쯔가무시증, 3위유행성이하선염으로동일한순위를보였고, www.cdc.go.kr 877
주간건강과질병 제 8 권제 37 호 Figure 1. Incidence of national infectious disease by year * Incidence rate is calculated as the reported s divided by the mid-year population in 2014 based on the resident registration (source : Korea National Statistical Office) Figure 2. Top 5 national infectious disease, 2013 70세이상에서만신증후군출혈열이 3위를차지하였다. 지역별감염병발생순위를보면 (Table 2), 감염병전체발생순위와큰차이는없음을알수있다. 부산, 대구, 인천, 대전, 울산, 경기, 강원, 충남, 전남, 경남, 제주에서는수두가발생률 1위를차지하였고, 서울, 충북, 경북, 세종에서는결핵이 1위를차지하였다. 광주, 전북에서는유행성이하선염이 1위를차지하여 2014 년에유행이있었음을확인할수있었다. 산모 B형간염은서울, 대구, 울산, 경기, 강원, 충북, 전남, 세종에서 4위또는 5위를차지하였다. 감염병별발생현황을보면 (Table 3), 제1군감염병 (Class I) 은공중위생환경개선으로전통적수인성감염병인콜레라, 파라티푸스, 세균성이질은발생이감소한반면, 지역사회내에서의소규모유행으로인해장티푸스및장출혈성대장균감염증의발생이증가하였고, A형간염또한증가하는양상을보였다. 878 www.cdc.go.kr
PUBLIC HEALTH WEEKLY REPORT, KCDC Table 1. Top 5 national infectious disease by age group, 2014 0~9years 10~19years 20~29years 30~39years ranking 1 Varicella 36,681 796.1 Mumps 15,770 258.1 Tuberculosis 4,206 63.6 Tuberculosis 4,027 50.9 2 Mumps 6,344 137.7 Varicella 5,568 91.1 Mumps 1,586 24.0 HBsAg(+) maternity** 2,743 34.7 3 Scarlet fever 5,603 121.6 Tuberculosis 1,246 20.4 Varicella 1,016 15.4 Mumps 737 9.3 4 Measles 191 4.1 Scarlet fever 195 3.2 HBsAg(+) maternity** 1,013 15.3 Varicella 693 8.8 5 EHEC** 67 1.5 Measles 142 2.3 HIV/AIDS 344 5.2 Viral hepatitis A 545 6.9 40~49years 50~59years 60~69years 70years ranking 1 Tuberculosis 4,996 56.0 Tuberculosis 5,894 72.6 Tuberculosis 4,391 95.7 Tuberculosis 10,048 230.8 2 Scrub typhus 681 7.6 Scrub typhus 1,774 21.8 Scrub typhus 2,065 45.0 Scrub typhus 3,003 69.0 3 Mumps 489 5.5 Mumps 239 2.9 Mumps 69 1.5 HFRS** 99 2.3 4 Varicella 314 3.5 HIV/AIDS 164 2.0 HFRS** 67 1.5 Mumps 52 1.2 5 Viral hepatitis A 288 3.2 Syphilis (primary) 123 1.5 HIV 66 1.4 Varicella 38 0.9 * Incidence rate(per 100,000 population) is calculated as the reported s divided by the mid-year population in 2014 based on the resident registration (source : Korea National Statistical Office) ** EHEC : Enterohemorrhagic E. coli, HBsAg(+) maternity : Viral hepatitis B(HBsAg(+) maternity), HFRS : Hemorrhagic Fever with Renal Syndrome www.cdc.go.kr 879
주간건강과질병 제 8 권제 37 호 Table 2. Top 5 national infectious disease by region, 2014 ranking Seoul Busan Daegu Incheon 1 Tuberculosis 6,831 67.5 Varicella 3,389 96.2 Varicella 2,945 117.9 Varicella 2,525 87.3 2 Varicella 4,641 45.8 Tuberculosis 2,548 72.3 Tuberculosis 1,881 75.3 Tuberculosis 1,766 61.1 3 Mumps 2,212 21.9 Mumps 2,459 69.8 Mumps 622 24.9 Mumps 838 29.0 4 5 ranking Scarlet fever HBsAg(+) maternity** 620 6.1 371 3.7 Scarlet fever Scrub typhus 545 15.5 521 14.8 Scarlet fever HBsAg(+) maternity** 376 15.1 234 9.4 HBsAg(+) maternity** Scarlet fever Gwangju Daejeon Ulsan Gyeonggi 319 11.0 204 7.1 1 Mumps 3,192 216.5 Varicella 1,238 80.8 Varicella 1,189 102.4 Varicella 13,584 110.5 2 Varicella 962 65.2 Tuberculosis 859 56.1 Tuberculosis 738 63.5 Tuberculosis 7,177 58.4 3 Tuberculosis 817 55.4 Mumps 436 28.5 Mumps 709 61.0 Mumps 4,813 39.1 4 Scrub typhus 345 23.4 Scrub typhus 300 19.6 Scrub typhus 480 41.3 Scarlet fever 1,612 13.1 5 ranking Scarlet fever 190 12.9 Scarlet fever 208 13.6 HBsAg(+) maternity** 177 15.2 HBsAg(+) maternity** Gangwon Chungbuk Chungnam Jeonbuk 1,084 8.8 1 Varicella 2,189 141.8 Tuberculosis 998 63.3 Varicella 1,917 93.3 Mumps 4,483 239.4 2 Tuberculosis 1,555 100.8 Varicella 704 44.7 Tuberculosis 1,506 73.3 Varicella 2,294 122.5 3 Mumps 751 48.7 Mumps 388 24.6 Mumps 852 41.5 Tuberculosis 1,304 69.6 4 5 ranking HBsAg(+) maternity** Scarlet fever 141 9.1 107 6.9 Scrub typhus HBsAg(+) maternity** 257 16.3 108 6.9 Scrub typhus Scarlet fever 819 39.9 297 14.5 Scrub typhus Scarlet fever Jeonnam Gyeongbuk Gyeongnam Jeju 959 51.2 266 14.2 1 Varicella 2,041 107.1 Tuberculosis 2,472 91.6 Varicella 2,400 71.8 Varicella 827 137.7 2 Tuberculosis 1,676 87.9 Varicella 1,569 58.1 Tuberculosis 2,295 68.7 Tuberculosis 375 62.4 3 Mumps 1,377 72.2 Mumps 575 21.3 Mumps 1,218 36.4 Mumps 318 52.9 4 Scrub typhus 1,374 72.1 Scrub typhus 440 16.3 Scrub typhus 1,169 35.0 Scarlet fever 77 12.8 5 ranking HBsAg(+) maternity** Sejong 217 11.4 1 Tuberculosis 71 51.0 2 Scrub typhus 49 35.2 3 Mumps 43 30.9 4 Varicella 36 25.9 5 HBsAg(+) maternity** 8 5.7 Scarlet fever 369 13.7 Scarlet fever 523 15.6 Scrub typhus 59 9.8 * Incidence rate(per 100,000 population) is calculated as the reported s divided by the mid-year population in 2014 based on the resident registration (source : Korea National Statistical Office) ** EHEC : Enterohemorrhagic E. coli, HBsAg(+) maternity : Viral hepatitis B(HBsAg(+) maternity), HFRS : Hemorrhagic Fever with Renal Syndrome 880 www.cdc.go.kr
PUBLIC HEALTH WEEKLY REPORT, KCDC Figure 3. Reported of Class I and Class II, 2013-2014 Figure 4. Reported of Class III and Class IV, 2013-2014 장티푸스 (Typhoid fever) 는 1970년대이전에는연간 3,000-5,000 명의환자가신고되다가이후지속감소하여 2000년대이후로는연간 200명내외의환자가신고되고있는감염병으로, 2014년에는경남지역을중심으로확인된유행과다른지역에서의발생증가로 251명이신고되어 2013년 (156명) 에비해 60.9% 증가하였다. 장출혈성대장균감염증 (Enterohemorrhagic Escherichia coli) 은 2000년법정감염병지정이후연간 100명미만으로신고되었으나, 2014년에는대구지역유치원에서의유행으로 111명이신고되어전년 (61명 ) 대비 82.0% 증가하였다. 월별로는 5-8월에 87명 (78.4%) 으로신고가가장많았고, 연령별로는 10세미만이 67명 (60.4%) 으로많이발생하였다. A형간염 (Hepatitis A) 은 2000년지정감염병으로지정되었다가 2010년제1군감염병으로변경되어감시체계가운영되고있다. 손씻기등개인위생개선노력과예방접종증가등으로 2009년발생정점 ( 표본감시, 15,231명 ) 이후감소추세를보였으나, 2014년에는 1,307명이신고되어전년 (867명) 대비 50.7% 증가하였다. 20-40대연령에서 1,161명 (88.8%) 으로대부분을차지하였다. 제2군감염병 (Class II) 인예방접종대상감염병은대부분 www.cdc.go.kr 881
주간건강과질병 제 8 권제 37 호 Table 3. Reported s of National Infectious s, 2005-2014 Group I II III IV s No. of reported s 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Cholera 16 5 7 5 0 8 3 0 3 0 Typhoid fever 190 200 223 188 168 133 148 129 156 251 Paratyphoid fever 31 50 45 44 36 55 56 58 54 37 Shigellosis 317 389 131 209 180 228 171 90 294 110 Enterohemorrhagic E. coli 43 37 41 58 62 56 71 58 61 111 Viral hepatitis A - - - - - - 5,521 1,197 867 1,307 Pertussis 11 17 14 9 66 27 97 230 36 88 Tetanus 11 10 8 16 17 14 19 17 22 23 Measles 7 28 194 2 17 114 42 3 107 442 Mumps 1,863 2,089 4,557 4,542 6,399 6,094 6,137 7,492 17,024 25,286 Rubella 12 18 35 30 36 43 53 28 18 11 Viral hepatitis B Acute - - - - - - 462 289 117 173 HBsAg(+) maternity - - - - - - 936 2,438 3,211 3,912 Perinatal - - - - - - 30 26 59 30 Japanese encephalitis 6 0 7 6 6 26 3 20 14 26 Varicella 1,934 11,027 20,284 22,849 25,197 24,400 36,249 27,763 37,361 44,450 Streptococcus pneumoniae - - - - - - - - - 36 Malaria 1,369 2,051 2,227 1,052 1,345 1,772 826 542 445 638 Tuberculosis 35,269 35,361 34,710 34,157 35,845 36,305 39,557 39,545 36,089 34,869 Hansen's disease 38 56 12 7 5 6 7 5 7 6 Scarlet fever 87 108 146 151 127 106 406 968 3,678 5,809 Meningococcal meningitis 7 11 4 1 3 12 7 4 6 5 Legionellosis 6 20 19 21 24 30 28 25 21 30 Vibrio vulnificus sepsis 57 88 59 49 24 73 51 64 56 61 Murine typhus 35 73 61 87 29 54 23 41 19 9 Scrub typhus 6,780 6,480 6,022 6,057 4,995 5,671 5,151 8,604 10,365 8,130 Leptospirosis 83 119 208 100 62 66 49 28 50 58 Brucellosis 158 215 101 58 24 31 19 17 16 17 Rabies 0 0 0 0 0 0 0 0 0 0 Hemorrhagic Fever with Renal Syndrome 421 422 450 375 334 473 370 364 527 344 AIDS (and HIV infection) 680 749 740 797 768 773 888 868 1,013 1,081 Primary - - - - - - 690 562 566 726 Syphilis Secondary - - - - - - 235 199 210 258 Congenital - - - - - - 40 26 22 31 Creutzfeldt-Jacob disease(cjd) - - - - - - 29 45 34 65 Dengue fever 34 35 97 51 59 125 72 149 252 165 Botulism 0 0 0 0 0 0 0 0 0 1 Q fever - 6 12 19 14 13 8 10 11 11 West Nile fever - - - - - - 0 1 0 0 Emerging infectious disease syndrome 0 0 0 0 706,911 56,850 0 0 0 0 Lime Borreliosis - - - - - - 2 3 11 13 Melioidosis - - - - - - 1 0 2 2 Chikungunya fever - - - - - - 0 0 2 1 Sever Fever with Thrombocytopenia Syndrome - - - - - - - - 36 55 Leishmaniasis 0 0 0 0 0 1 - - - - Babesiosis 1 0 0 0 0 0 - - - - Cryptosporidiosis 1 0 0 0 0 0 - - - - Schistosomiasis 0 0 2 1 0 0 - - - - 1) Excludes Infectious diseases for Sentinel Surveillance System. 2) No. of notifications contains all classifications of the disease(confirmed, Suspected, Asymptomatic carrier) respectively. 3) The Viral hepatitis A, Viral hepatitis B, Syphilis and Creutzfeldt-jacob disease, West Nile fever were newly categorized to mandatory surveillance from sentinel surveillance by revision of "the Infectious Prevention and Control Act" in 2010. 4) The Leishmaniasis, Babesiosis, Cryptosporidiosis and Schistosomiasis were newly categorized to sentinel surveillance from mandatory surveillance by revision of "the Infectious Prevention and Control Act" in 2010. 5) No s of Diphtheria, Poliomyelitis, Haemophilus influenzae type b, Epidemic typhus, Anthrax, Plague, Yellow fever, Viral hemorrhagic fever(marburg virus, Ebola virus, Lassa virus etc), Smallpox, Severe Acute Respiratory Syndrome(SARS), Avian influenza infection in humans, Novel influenza, Tularemia, Tick-borne Encephalitis were notified during 2001-2013. 6) 0: No notified s, -: Not notifiable. 7) Emerging infectious disease syndrome of 2009, 2010 is influenza A(H1N1)pdm09. 882 www.cdc.go.kr
PUBLIC HEALTH WEEKLY REPORT, KCDC 퇴치되고있으나해외유입및국내 2차전파를통한확산으로홍역이증가하였고, 유행성이하선염및수두의발생이지속증가하고있다. 백일해 (Pertussis) 는 1954년백신도입이후환자발생이급격히감소하였고, 1995년이후로는소규모발생을보여 2001년이후에는매년 20명내외의환자가신고되었다. 2012년에는전남지역중 고등학교를중심으로유행하여크게증가하였다가 2013년 36명으로감소하였고, 2014년에는 88명이신고되어전년대비 144.4% 증가하였다. 10세미만에서 56명 (63.6%) 으로가장많이발생하였다. 홍역 (Measles) 은 2000-2001 년의대규모유행이후발생이급격히감소하였다가, 2013년경남과경기지역에서해외유입바이러스에의해의료기관, 학교, 지역사회, 가족전파에의한유행으로 107명이신고되었고, 2014년에도해외유입사례에의한국내 2차전파로병원을중심으로면역력이불충분한소아, 접종력이없는집단생활청소년및대학생까지확산되어 442명이신고되어전년대비 4배정도증가하였다. 연령별로는 10대미만에서 191명 (43.2%), 10대에서 142명 (32.1%) 순으로발생하였다. 유행성이하선염 (Mumps) 은 2006년까지 2,000명내외로신고되었고, 이후지속증가하여 2014년에는 25,286명으로전년 (17,024명) 대비 48.5% 증가하였다. 백신의효과가홍역이나풍진에비해낮아 2회접종을해도면역이충분치않아중 고등학교에서유행이지속되어발생규모가증가하였다. 18세이하연령에서전체환자의 86.1% 가발생하였다. 수두 (Varicella) 는 2005년법정감염병으로지정된후신고율향상등의영향으로꾸준히신고가증가하고있는감염병으로, 2014 년도에는 44,450 명이신고되어전년 (37361 명 ) 대비 19.0% 증가하였다. 연령별로는전체환자의 94.2% 가 16세이하였으며, 이중 3-8 세가가장많아전체의 65.0% 로발생하였다. 폐렴구균 (Streptococcus pneumoniae) 은 2014년 9월법정감염병으로신규지정되어 36명이신고되었다. 이중 40세이상에서 32명 (88.9%) 으로대부분을차지하였다 (Figure 3). 제3군감염병 (Class III) 중말라리아는적극적인말라리아 퇴치사업을통해퇴치전단계로진입하여유지중이고, 성홍열은지속증가하고있으며, 쯔쯔가무시증은 2013년보다다소감소하였다. 말라리아 (Malaria) 는대표적인재출현감염병으로 1970 년대후반이후발생이없다가 1993년부터다시환자가발생하여 2000년 4,142명까지증가하였으나이를정점으로하여말라리아퇴치사업의노력으로 2013년 445명까지지속감소하였다. 1996년이전에는 87-100% 환자가군인이었으나, 점차감소하여 1997-2000 년에는 60-80% 가군인이었고 2007년이후에는약 40% 로낮아지면서현재까지민간인위주의환자발생이보고되고있다. 2014년에는 638명으로전년 (445명) 대비 43.4% 증가하였으며, 이중국내발생은 558명 ( 민간인 402명, 전역자 58명, 군인 98명 ), 국외유입은 80명이었다. 이는전년과비교하여민간인 77.1%, 해외유입건은 33.3% 증가한수치이다. 월별로는 6-9월 (79.0%) 에가장많이발생하였다. 성홍열 (Scarlet fever) 은역학적특성과검사현황등을반영한진단 신고기준변경으로 2012년 9월성홍열신고범위가기존환자에서환자및의사환자로확대되었고, 2013년 9월의사환자의신고범위가항원검출법을시행하지않은의심환자까지확대됨에따라발생보고가지속적으로증가하고있다. 2014년에는 5,809명으로전년 (3,678명) 대비 57.9% 증가하였다. 10세미만에서전체발생의 96.5% 가신고되었다. 쯔쯔가무시증 (Scrub typhus) 은 2009년이후매년증가추세로질병매개체밀도와활성도증가등의요인으로추정하고있으며, 1994년감시를시작한이후 2013년에가장많은발생이보고 (10,365 건 ) 되었다. 2014년에는 8,130명으로소폭감소하였다. 월별로는 10-12 월 (93.8%) 에집중되어발생하며, 40대이상이 92.5% 이고여자가남자보다 1.6 배더많았다. 제4 군감염병 (Class IV) 중뎅기열은해외에서의발생이감소하여해외여행객에의한국외유입건수도감소하였다. 또한, 진드기에의한라임병, 중증열성혈소판감소증후군도지속발생하고있다. 뎅기열 (Dengue fever) 은모두해외유입으로인한발생으로 2013 년해외에서의유행에의해 252명으로크게증가하였으나 www.cdc.go.kr 883
주간건강과질병 제 8 권제 37 호 Table 4. Number and percentage of imported s by region of acquisition, 2014 Imported region Total Asia Philippines Indonesia Vietnam India China Cambodia Thailand Malaysia others Africa others Unknown s (%) 400 (100%) 92 (23.0%) 34 (8.5%) 28 (7.0%) 26 (6.5%) 23 (5.8%) 22 (5.5%) 22 (5.5%) 17 (4.3%) 59 (14.8%) 66 (16.5%) 9 (2.3%) 2 (0.5%) 2014 년에는해외발생이감소함에따라해외유입건수도 165 명으로감소하였다. 주로동남아시아 ( 필리핀, 태국, 인도네시아, 말레이시아 ) 여행객에의한발생으로보고되었다. 유비저 (Meliodiosis) 는해외에서유입된 60대남자 2명의환자가신고되었고, 치쿤구니야열 (Chikungunya fever) 은해외에서유입된 10대남자 1명이신고되었다. 감시이후모두국외에서감염된사례로확인되었으며, 국내발생은없었다. 중증열성혈소판감소증후군 (SFTS) 은 2013년 9월에법정감염병으로신규지정되어 2013년 36건, 2014 년 55건이보고되었다. 월별로는 6-10 월에 50명 (90.9%) 이신고되었고, 지역별로는경북 19명, 경기 8명, 제주 7명, 서울 경남각 5명순이었으며, 발생환자의 83.6% 가 50세이상 (46명) 이었다. 해외유입감염병은 2009년까지 200명내외로신고되다가 2010 년 352 명, 2013 년에는 494 명으로지속적으로증가하고있다. 2014 년에는 400명이신고되어전년대비소폭감소하였다. 이는뎅기열유입감소에의한것으로동남아시아여행객이많은우리나라는그지역의뎅기열유행에큰영향을받기때문이다. 2014 년에신고된주요해외유입감염병은뎅기열 (41.0%), 말라리아 (20.0%), 세균성이질 (9.5%), 장티푸스 (5.5%), A형간염 (5.3%), 홍역 (5.3%) 등순이었으며, 주요유입국가는필리핀, 인도네시아, 베트남, 인도, 중국, 캄보디아, 태국, 말레이시아등의아시아지역 (80.8%) 과가나, 적도기니등의아프리카지역 (16.5%) 이대부분이었다 (Table 4). 맺는말 2014 년도감염병신고환자수는총 128,678 명으로전년대비 14.0% 증가하였다. 지난해보다증가한주요감염병은장티푸스, 장출혈성대장균감염증, A형간염, 백일해, 홍역, 유행성이하선염, 수두, 말라리아, 성홍열, 중증열성혈소판감소증후군등이었고, 감소한주요감염병은세균성이질, 풍진, 쯔쯔가무시증, 신증후군출혈열, 뎅기열등이었다. 수두, 결핵, 유행성이하선염, 쯔쯔가무시증, 성홍열등다발 5종감염병은전체발생의 92.1% 를차지하였다. 이러한감염병감시결과에대한해석을할때는감염병발생의실제증가인지아니면새로운감염병의도입이나감시방법의변화, 새로운진단법의개발, 의료인의신고율향상등과같은외적요인에의한영향인지에대한판단과이해가필요하다. 새로운감염병의발견이나감염병관리등법정감염병지정의필요에따라법정감염병수는증가 (2000년 58개 2014년 78개 ) 하고있으며이로인해감염병발생의총량은증가하고있다. 결핵, 유행성이하선염등일부감염병은국내유행이지속되고있고, 수두, 성홍열등은의료기관의신고율향상및진단 신고기준의확대로인해증가하는양상을보이고있다. 또한, 해외유입바이러스를통한국내 2차전파사례의증가와지역사회에서의소규모유행이산발적으로발생하고있다. 이렇듯감염병발생의패러다임은변화하고있으며이에따른감염병별 884 www.cdc.go.kr
PUBLIC HEALTH WEEKLY REPORT, KCDC 효과적관리및감시를위한관리체계개선, 신종감염병발생에대한조기인지와대응방안마련을위한노력이요구된다. 전세계적감염병의발생과확산으로감염병은이제더이상한나라의문제가아니며, 국제사회의협력을통해신속하게인지하고관리하여확산을방지하기위한역량강화및기술개발이절실히필요하다. 참고문헌 1. 질병관리본부감염병감시과. 2014. 법정감염병진단 신고기준. 2. 질병관리본부감염병감시과. 2014. 감염병감시연보. 3. 질병관리본부에이즈결핵관리과. 2014. 결핵환자신고현황연보. 4. 질병관리본부에이즈결핵관리과. 2014. HIV/AIDS 신고현황연보. www.cdc.go.kr 885
주간건강과질병 제 8 권제 37 호 해외여행후 Plesiomonas shigelloides 감염에의한설사환자발생사례보고 A Case Report Foreign Travel-Associated Plesiomonas Shigelloides Infection Abstract In August, the National Quarantine Station in Mokpo-si reported the isolation of Plesiomonas shigelloides from the stool of a 1-old student who displayed symptoms of stomachache and watery diarrhea. The patient had travel history in China. The main measure in preventing P. shigelloides infection is meticulousness with personal hygiene when traveling to tropical and subtropical countries. 질병관리본부목포검역소, 감염병센터수인성질환과 김형석, 류강희, 김준영, 정경태, 유천권 1) Plesiomonas shigelloides 감염은급성장관계감염질환으로위장염이가장일반적인임상증상이며장외감염시에는패혈증을유발하거나드물게는뇌수막염이나담낭염을일으킨다 [1, 2]. 이병원체는 1947년에 Ferguson과 Henderson에의해처음분리되었고 1962 년 Habs와 Schubert에의해 Shigelloides로명명되었으며그이전에는 paracolon C27로불렸었다 [3]. P. shigelloides 는원래 Aeromonas 속 Vibrionaceae 과로구분되어있었으나최근에 ribosomal RNA 작은소단위염기서열분석결과, Enterobacteriaceae과와더밀접한관계를갖는것으로확인되어현재재분류되었다. P. shigelloides 는통성혐기성그람음성간균으로 oxidase 양성이며 lactose를발효시키지않는다. 체세포항원과편모항원의형태에따라 102종의 O혈청형과 51종의 H혈청형으로세분된다. 특히 O polysaccharide의 4 C 1 chair 형태가 P. shigelloides(o17형제외 ) 와 Shigella sonnei가완벽하게일치되어혈청반응에서교차응집을보이기때문에이균을확인동정하기위해서는 cytochrom oxidase 반응등생화학적성상확인을통한구별이반드시필요하다 [4, 5]. P. shigelloides 는연안생태계의상재균으로해수, 어패류등을통해경구감염되는경우가가장많으며오염된식수나파충류, 소, 돼지, 가금류등을통해서전염되기도한다. 세계적으로는 2001 2002년태국서부지역 10%, 2004 2008년에콰도르북서부지역 11.4%, 2001 2012 년중국동남부지역, 2013년나이지리아 1.7% 로유행적집단발생이지속되고있는것으로보고되고있다 [6, 7]. 특히 2003년에홍콩지역에서는응급실에내원한위장염환자의 9% 가 P. shigelloides의감염에의한것으로확인되어국가적문제로대두되었으며최근멕시코, 중앙아메리카, 동남아시아등을방문한여행객에서감염사례보고가급증하고있지만아직까지국내로유입된사례보고가없었다 [8, 9]. 그러나 년 8월 4일, 중국을다녀온여행단중 1명의학생 (15세) 이복통을동반한설사증상을국립목포검역소에자진신고하였고, 8월 7일환자의설사검체에서 P. shigelloides를분리하여보고하였다. 환자는 년 7월 31일부터 8월 4일까지가족및친인척 18명과중국무안, 베이징및북경지역을여행하였고 2일점심이후복통과설사증상을보였다. 다른여행객은대부분무증상을보였으나이중 4명도복통증세를보였던것으로확인되었다. 최초환자를보고한목포검역소와해당여행단의거주지역보건소에서는증상이확인된환자와접촉자 19명의대변검체를확보하여세균및바이러스에대한진단검사를실시하였다. 초기설사환자대변검체에분리된병원체는 lactose와 xylose를분해하지못하고 H 2 S를생성하지못했으며 S. sonnei Phase I 혈청형에강한교차반응을보여세균성이질균으로의심되었다. 1) 교신저자 (gtchung@nih.go.kr/ 043-719-8111) 886 www.cdc.go.kr
PUBLIC HEALTH WEEKLY REPORT, KCDC 그러나이후 API 20E Kit와 VITEK 자동화장비를통한실험에서 oxidase, indole, arginine dihydorolase 및 lysine decarboxylase에양성반응을보였고 lipase와 DNase의음성반응을보여생화학적으로 99.9% P. shigelloides임을확인하였다. 또분리된병원체를대상으로중합효소연쇄반응을이용하여세균성이질균의표지유전자인 ipa H 유전자와 inv 유전자의보유여부를확인하였으나해당유전자는증폭되지않았으며장내세균항균제감수성확인용판넬을이용하여내성경향을확인한결과 ampicillin, ticarcillin, amoxillin/ clavulanic acid, cephalothin, cefoxitin, ceftriaxone, chloramphenicol, gentamicin, streptomycin, kanamycin, amikacin, tetracycline, nalidixic acid, ciprofloxacin, trimethoprim/sulfamethoxazole, imipenem 16개항균제모두감수성이었다. 일반적으로정상인이 P. shigelloides 감염되었을경우는항균제치료없이경과를보고자연회복을유도하기도하지만 2차감염에의한추가발생등을고려하여검사를수행한결과이외복통증상을보이는 4명의환자에서는병원성대장균 (ETEC) 이분리되었으나무증상접촉자 11명에서는검사결과모두음성으로확인되었다. 역학조사반은 P. shigelloides 감염환자가해외여행후에증상을보인것으로판단하고해당여행단과면담을통하여감염경로를추적하고자했다. 이들은동일한경로로여행하였고음용수는생수를구입하여섭취하였으며모두현지식만을섭취했다는점과여행단중 5명이세균감염환자라는정황을종합할때, 중국여행중에섭취한음식물에의한감염가능성이높다고판단하였다. 그러나감염경로추적과정은최초감염증상이여행을하는도중확인되어신고가늦게되었고여행지역시해외였기때문에감염원추적에는한계가있었으며, 음식물섭취에의한감염으로추정될뿐객관적인증거확보가제한적이었다. 이번환자에서분리된 P. shigelloides 는법정감염병인세균성이질균의항혈청 D에강한반응을일으켰고운동성이아주약했으며 MacConkey 배지에서무색집락으로확인되는등의특징을보였기때문에초기이균주는혼란이야기되어진단에많은어려움이있었다. 따라서, 이처럼국내에보고되지않은 병원체들의국내유입및유행예방을위해서는신속하고정확한확인동정능력을보유하기위한일선보건의료기관임상미생물실험실들의대비가필요하고생각한다. 확인된 P. shigelloides 는비교적약한병원성을갖고있는것으로알려져있다. 하지만건강한사람에게도감염을유발할수있고신생아나면역력이저하된사람에게노출되었을경우에감염빈도가높아져서뇌수막염, 자궁근염, 패혈증, 골수염, 담낭염, 패혈성관절염, 흉수감염등심한임상증상으로치명적일수있다고보고된다 [8]. 아직까지국내에서는이균에의한감염사례가아주드물게보고되고있지만열대및아열대환경국가에서는집단발병사례보고가계속해서증가하고있는상황이었기때문에이번해외여행을통해국내유입된첫감염사례는의의로크다. 한국관광공사의관광통계에서따르면최근우리나라는일본, 동남아, 중국등근거리해외여행객이크게증가하고있는상황이어서본사례와같이해외여행에의한감염사례는계속해서증가할것으로판단된다. 이러한상황을감안할때, 해외에서입국한감염환자가발생할경우유행에대한조속한인지와방역조치를할수있는제도적장치의보완이중요할것으로생각되며해외여행객을대상으로철저한개인위생수칙준수및현지음식과음료섭취시주의에대한집중홍보가필요하다. 참고문헌 1. Brenden RA, Miller MA, Janda JM. 1988. Clinical disease spectrum and pathogenic factors associated with Plesiomonas shigelloides infections in human. Rev Infec Dis. 10: 303-316 2. Eason JD, Peacock D. 1996. Plesiomonas shigelloides septicemia and meningitis in a neonate. Can J Infect Dis. 7: 380-382 3. Ferguson WW, Henderson ND. 1947. Description of Strain C27: a motile organism with the major antigen of Shigella sonnei PhaseI. J Bacteriol. 54: 179-181 4. Aldova E, Shimade T. 2000. New O and H antigens of the international antigenic scheme for Plesiomonas shigelloides. Folla Microbiol. 45: 301-304 www.cdc.go.kr 887
주간건강과질병 제 8 권제 37 호 5. Batta G, Liptak A, Schneerson R, Pozsgay V. 1988. Conformational stabilization of the altruronic acid residue in the O-specific polysaccharide of Shigella sonnei/plesiomonas shigelloides. Carbohydr Res. 305: 93-99 6. Badhidatta L, McDaniel P, Sornsakrin S, Srijan A, et al. 2010. Case-control study of diarrheal disease etiology in remote rural area in Western Thailand. Am J Trop Med Hyg. 83: 1106-1109 7. Escobar JC, Bhavnani D, Trueba G, Ponce K, et al. 2012. Plesiomonas shigelloides infection, Ecuador, 2004-2008. Emerg Infect Dis. 18: 322-324 8. Kain KC, Kelly MT. 1989. Clinical features, epidemiology, and treatment of Plesiomonas shigelloides diarrhea. J Clin Microbiol. 27: 998-1001 9. Chan SS, Ng KC, Lyon DJ, Cheung WL, et al. 2003. Acute bacterial gastroenteritis: a study of adult patients with positive stool cultures treated in the emergency department. Emerg Infect Dis. 20: 335-338 888 www.cdc.go.kr
36th (8.30-9.5) status of selected infectious diseases 1. Hand, Foot and Mouth (HFMD) Republic of Korea, s ending September 5, (36th Week)* 년도제36주수족구병의사환자분율은외래환자 1,000 명당 6.0 명이며, 2014 년동기간수족구병의사환자분율 7.0 명보다낮음. 잠정통계이므로변동가능함 수족구병은 2009 년 6 월법정감염병으로지정되어표본감시체계로운영되고있음. No. of HFMD per 1,000 consultation 40.0 30.0 20.0 10.0 문의 : (043) 719-7167, 7172 0.0 1 5 9 13 17 21 25 29 33 37 41 45 49 2014 2013 2012 Figure 1. The status of HFMD sentinel surveillance, 2012-2. Ophthalmologic, Republic of Korea, s ending September 9, (36th ) 년도제36주유행성각결막염의외래환자 1,000 명당분율은 28.4 명으로지난주 30.9 명보다감소하였음 동기간급성출혈성결막염의환자분율은 2.7 명으로지난주 2.5 명보다증가하였음 문의 : (043) 719-7175 80 40 10.0 50.7 30.0 45.7 60 30 8.0 24.0 EKC per 1,000 40 20 Case//sentinel AHC per 1,000 6.0 18.0 4.0 12.0 Case//sentinel 20 10 2.0 6.0 0 0 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 0.0 0.0 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 2014 2013(36~) 10years average 2013//sentinel(1~35) 2014 2013(36~) 2003-2013 2007, 2012 2013//sentinel(1~35) Figure 2-1. The mean of outpatients to Epidemic keratoconjunctivitis for a Figure 2-2. The mean of outpatients to Acute hemorrhagic conjunctivitis for a 3. Influenza, Republic of Korea, s ending September 5, (36th ) 년도제 36 주인플루엔자의사환자분율은외래환자 1,000 명당 5.2 명으로지난주 (4.5) 보다증가 -2016 절기유행기준은 11.3 명 (/1,000) 문의 : (043) 719-7167, 7172 ILI per 1,000 80 70 60 50 40 30 20 10 0 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34-2016 2014-2013-2014 2012-2013 Figure 3. The ly proportion of Influenza-Like Iliness per 1,000 outpatients, 2012-2013 to -2016 seasons www.cdc.go.kr 889
36th (8.30-9.5) Table 1. Reported s of national infectious diseases in Republic of Korea, ending September 5, (36th Week)* Group Ⅰ Group Ⅱ Group Ⅲ Group Ⅳ Abbreviation: EHEC= Enterohemorrhagic Escherichia coli, HFRS= Hemorrhagic fever with renal syndrome, CJD/vCJD= Creutzfeldt-Jacob /variant Creutzfeldt-Jacob, SFTS= Severe fever with thrombocytopenia syndrome, MERS-CoV= Middle East Respiratory Syndrome Coronavirus. Cum: Cumulative counts from 1st to current in a year. * The reported data for year are provisional data but the data for years 2010, 2011, 2012, 2013 and 2014 are finalized data. According to surveillance data, the reported s may include all of the s such as confirmed, suspected, and asymptomatic carrier in the group. The reported surveillance data excluded Hansen s disease and no data such as Diphtheria, Poliomyelitis, Haemophilus influenzae type b, Epidemic typhus, Anthrax, Plague, Yellow fever, Viral hemorrhagic fever, Smallpox, Severe Acute Respiratory Syndrome, Animal influenza infection in humans, Novel Influenza, Tularemia, Newly emerging infectious disease syndrome and Tick-borne Encephalitis. Surveillance system for Viral hepatitis A, Viral hepatitis B, Syphilis, CJD/vCJD, West Nile fever was changed from Sentinel Surveillance System to National Infectious Surveillance System as of December 30, 2010. Calculated by summing the counts for the current, the 2 s preceding the current, and the 2 s following the current, for a total of 5 preceding years (For Viral hepatitis A, Viral hepatitis B, Syphilis, CJD/vCJD, West Nile fever, Lyme Borreliosis, Melioidosis, this calculation only used 4-year data (2011, 2012, 2013, 2014) because of being designated as of December 30, 2010. ** Data on viral hepatitis B included acute viral hepatitis B, HBsAg positive maternity and perinatal hepatitis B virus infection. Data on scarlet fever included both s of confirmed and suspected since September 27, 2012. 문의 : (043) 719-7176 890 Classification of disease ly average Total no. of s by year 2014* 2013 2012 2011 2010 Cholera - - - - 3-3 8 unit: no. of s Imported s of current : Country(no. of s) Typhoid fever 3 100 3 251 156 129 148 133 Pakistan(1) Paratyphoid fever 3 32 2 37 54 58 56 55 Shigellosis 6 72 3 110 294 90 171 228 Philippines(2), Nepal(1) EHEC 1 61 2 111 61 58 71 56 Viral hepatitis A 36 1,383 37 1,307 867 1,197 5,521 - Pertussis 6 174 2 88 36 230 97 27 Tetanus - 18-23 22 17 19 14 Measles 3 25-442 107 3 42 114 Mumps 334 17,055 153 25,286 17,024 7,492 6,137 6,094 Rubella 1 21 1 11 18 28 53 43 Viral hepatitis B ** 72 2,679 58 4,115 3,387 2,753 1,428 - Japanese encephalitis 2 4 1 26 14 20 3 26 Varicella 271 29,323 220 44,450 37,361 27,763 36,249 24,400 Malaysia(1) Streptococcus pneumoniae 3 181-36 - - - - Malaria 23 574 36 638 445 542 826 1,772 Scarlet fever 73 4,530 9 5,809 3,678 968 406 106 Meningococcal meningitis - 8-5 6 4 7 12 Legionellosis 1 26 1 30 21 25 28 30 Vibrio vulnificus sepsis 3 17 4 61 56 64 51 73 Murine typhus - 8 1 9 19 41 23 54 Afghanistan(1), Nigeria(1), Equatorial Guinea(1), South Sudan(1), Sudan(1) Scrub typhus 27 395 10 8,130 10,365 8,604 5,151 5,671 Malaysia(1) Leptospirosis 3 27 1 58 50 28 49 66 Brucellosis 2 29-17 16 17 19 31 Rabies - - - - - - - - HFRS 8 142 5 344 527 364 370 473 Syphilis 20 691 17 1,015 798 787 965 - CJD/vCJD 1 52 1 65 34 45 29 - Tuberculosis 755 23,047 715 34,869 36,089 39,545 39,557 36,305 HIV/AIDS 17 666 22 1,081 1,013 868 888 773 Dengue fever 13 142 6 165 252 149 72 125 Botulism - - - 1 - - - - Q fever 1 28-11 11 10 8 13 West Nile fever - - - - - 1 - - Lyme Borreliosis - 12-13 11 3 2 - Melioidosis - 3-2 2-1 - Chikungunya fever - 1-1 2 - - - SFTS - 46-55 36 - - - MERS-CoV - 186 - - - - - - Philippines(6),Myanmar(2), Bangladesh(1), India(1), Indonesia(1), Laos(1), Thailand(1)
36th (8.30-9.5) Table 2. Reported s of national infectious diseases in Republic of Korea, ending September 5, (36th Week)* unit: no. of s Provinces Cholera Typhoid fever Paratyphoid fever Shigellosis Enterohemorrhagic Escherichia coli Viral hepatitis A Pertussis Tetanus 4-year average Total - - 1 3 100 125 3 32 36 6 72 106 1 61 57 36 1,383 1,499 6 174 163-18 11 Seoul - - 1-21 24-6 10 3 16 21-7 11 9 257 287-18 9-2 1 Busan - - - - 3 8 1 4 2 1 3 9-2 3-28 57-19 2-2 2 Daegu - - - - 3 6 - - 1-1 4 - - 9-34 16-1 46 - - - Incheon - - - - 3 5-2 3-11 12 - - 4 1 167 225-4 6 - - - Gwangju - - - - 1 5-1 2 - - 3 1 30 7 3 69 47 1 9 2-1 - Daejeon - - - - 14 3-1 1-2 1-1 1-40 41 - - 46 - - - Ulsan - - - - - 2 - - 1 - - 2 - - 5 1 11 15-2 - - - - Sejong - - - - - - - - - - 1 - - 2-1 4 1-1 - - - - Gyonggi - - - 1 16 21-6 7 1 11 25-3 5 12 501 499 3 15 6-1 1 Gangwon - - - - - 2 1 1 1 - - 1 - - - 4 40 54-3 1-3 1 Chungbuk - - - - 2 2 - - 2-2 2-3 - 1 43 48 - - - - - - Chungnam - - - - 3 5-1 1 1 4 5-1 5-39 54-6 4 - - 1 Jeonbuk - - - - 3 2-2 1 - - 2 - - - 2 48 69-1 - - 1 - Jeonnam - - - 1 14 4-2 1-3 8-6 3 1 61 33-9 35-3 1 Gyeongbuk - - - - 2 8-1 1-3 2-1 2-18 23 1 18 3-2 2 Gyeongnam - - - 1 14 28-4 2-15 8-3 1 1 18 25 1 66 2-3 2 Jeju - - - - 1-1 1 - - - 1-2 1-5 5-2 1 - - - Cum: Cumulative counts from 1st to current in a year * The reported data for year are provisional data but the data for years 2010, 2011, 2012, 2013 and 2014 are finalized data. According to surveillance data, the reported s may include all of the s such as confirmed, suspected, and asymptomatic carrier in the group. Viral hepatitis A data on sentinel surveillance system changed to National Infectious Surveillance System as of December 30, 2010. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years. www.cdc.go.kr 891
36th (8.30-9.5) Table 2. Reported s of national infectious diseases in Republic of Korea, ending September 5, (36th Week)* unit: no. of s Measles Mumps Rubella Viral hepatitis B Japanese encephalitis Varicella Malaria Scarlet fever Provinces 4-year average Total 3 25 141 334 17,055 7,405 1 21 31 72 2,679 1,665 2 4-271 29,323 21,178 23 574 693 73 4,530 1,056 Seoul - 4 22 31 1,246 824-6 4 5 245 140 1 1-34 3,063 1,950 5 68 95 9 492 155 Busan 1 3 5 31 1,251 545-2 5 11 242 212 - - - 18 1,928 1,963-3 15 7 339 119 Daegu - 2 2 10 466 295-2 2 3 108 95-1 - 14 1,535 1,622 1 4 10 2 246 91 Incheon - 3 31 20 554 593 - - 1 3 157 146 - - - 15 1,503 1,715 5 99 120 2 166 67 Gwangju - - 1 15 1,378 424 - - - 2 134 88 - - - 8 705 557-1 4 4 180 55 Daejeon 1 1 3 2 210 443-1 - 1 11 8 1 1-4 643 415-4 5 4 184 26 Ulsan - - 1 14 648 257 - - 1 5 94 80 - - - 7 914 719-4 4 8 221 34 Sejong - - - 3 21 20 - - - - 22 4 - - - - 44 31-1 - - 4 3 Gyonggi 1 8 33 82 3,868 1,498-4 8 19 804 368 - - - 64 8,571 5,518 9 334 325 17 1,332 41 Gangwon - 2 1 5 412 361 - - 1 1 76 82 - - - 13 1,114 1,401-19 60-73 22 Chungbuk - - 2 6 267 173-1 1 1 50 45 - - - 7 589 565-7 8 2 70 23 Chungnam - 1 3 10 476 290 - - 1 1 78 42 - - - 16 996 818 1 8 7 1 231 65 Jeonbuk - - 1 19 2,077 503 - - 1 3 97 57 - - - 15 1,395 647-6 9 2 124 79 Jeonnam - - 9 21 1,054 247-2 1 4 136 89 - - - 12 1,604 709 1 4 6 6 196 33 Gyeongbuk - - 5 10 745 265-2 3 4 160 65-1 - 14 1,267 750 1 5 10 2 212 118 Gyeongnam - 1 22 52 2,244 398 1 1 2 9 249 128 - - - 25 2,894 1,160-5 12 7 438 105 Jeju - - - 3 138 269 - - - - 16 16 - - - 5 558 638-2 3-22 20 Cum: Cumulative counts from 1st to current in a year * The reported data for year are provisional data but the data for years 2010, 2011, 2012, 2013 and 2014 are finalized data. According to surveillance data, the reported s may include all of the s such as confirmed, suspected, and asymptomatic carrier in the group. Viral hepatitis B data on sentinel surveillance system changed to National Infectious Surveillance System as of December 30, 2010. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years. Data on scarlet fever included both s of confirmed and suspected since September 27, 2012. 892
36th (8.30-9.5) Table 2. Reported s of national infectious diseases in Republic of Korea, ending September 5, (36th Week)* unit: no. of s Provinces Meningococcal meningitis Legionellosis Vibrio vulnificus sepsis Murine typhus Scrub typhus Leptospirosis Brucellosis Hemorrhagic fever with renal syndrome Total - 8 3 1 26 18 3 17 25-8 10 27 395 222 3 27 10 2 29 15 8 142 130 Seoul - 1 1 1 8 4-1 2-2 3 1 20 12-2 - - 2-1 8 8 Busan - 3 - - - 3 1 2 3-2 1-20 16-3 1 - - - - 3 5 Daegu - - - - - - - - - - - - 1 5 5 1 1 - - 7 1-1 - Incheon - - - - 2-1 1 1 - - 1 1 5 8 - - - - - - - 4 5 Gwangju - - - - - - - - - - 1 - - 5 3 - - - - - - - - 1 Daejeon - - - - - - - - 1 - - - 3 16 9 - - 1-1 2-2 2 Ulsan - - - - 3 - - - - - - - - 6 6 - - - - - 1-1 1 Sejong - - - - - - - - - - - - - 2 1 - - - - - - - 1 - Gyonggi - 1 1-3 3-3 5-1 2 4 43 32-4 2-1 - 2 50 39 Gangwon - 1 - - 6 3 - - - - - - 4 33 7-1 1 - - - 1 13 14 Chungbuk - - - - 1 1 - - - - - 1 - - 5 - - - 1 4 1-5 9 Chungnam - - 1-1 1 - - 1 - - 1-29 17-3 1-2 2-13 10 Jeonbuk - - - - - 1-2 1 - - - - 26 27 1 1 1-1 3 1 9 8 Jeonnam - - - - 1-1 4 5-1 - 7 85 30-3 1-1 - 2 15 10 Gyeongbuk - - - - - 1-2 1-1 1-18 12 1 4 1 1 8 3-7 14 Gyeongnam - 2 - - - 1-2 5 - - - 6 79 28-5 1-2 1 1 10 4 Jeju - - - - 1 - - - - - - - - 3 4 - - - - - 1 - - - Cum: Cumulative counts from 1st to current in a year * The reported data for year are provisional data but the data for years 2010, 2011, 2012, 2013 and 2014 are finalized data. According to surveillance data, the reported s may include all of the s such as confirmed, suspected, and asymptomatic carrier in the group. Calculated by averaging the cumulative counts from 1st to current, for a total of 5 preceding years www.cdc.go.kr 893
36th (8.30-9.5) Table 2. Reported s of national infectious diseases in Republic of Korea, ending September 5, (36th Week)* unit: no. of s Syphilis CJD/vCJD Dengue fever Q fever Lyme Borreliosis Melioidosis SFTS Tuberculosis Provinces 4-year average 4-year average 4-year average 4-year average 2-year average Total 20 691 473 1 52 27 13 142 100 1 28 6-12 2-3 - - 46 10 755 23,047 26,459 Seoul 5 93 74 1 5 5 4 51 28-2 1-7 1 - - - - - 1 133 4,347 5,386 Busan - 41 36-5 2-9 8-2 - - 1 - - - - - - - 61 1,768 2,163 Daegu 1 40 19-7 3 1 6 4-3 - - - - - - - - 3-45 1,116 1,447 Incheon - 44 49 - - 1-4 5 - - - - - - - - - - - - 40 1,166 1,359 Gwangju - 20 14-1 1 - - 1 - - - - 1 - - - - - - - 22 612 664 Daejeon - 13 10-1 1 1 9 5-1 - - - - - 1 - - 2 1 19 512 650 Ulsan - 10 8-1 - - 2 1 - - - - 1 - - - - - 2-13 470 592 Sejong - 1 - - - - - 1 - - - - - - - - - - - - - 3 45 52 Gyonggi 8 221 114-12 6 3 32 27-1 1 - - 1-1 - - 3 1 163 4,954 5,125 Gangwon 1 17 18-4 1 1 4 1 - - - - - - - - - - 4 1 38 981 962 Chungbuk 2 11 14 - - 1 - - 2 1 7 1 - - - - 1 - - - 1 17 650 820 Chungnam - 26 15-2 1 1 4 3-5 2 - - - - - - - 4-41 1,002 1,065 Jeonbuk - 19 15-3 1 - - 3 - - - - - - - - - - 1-19 847 972 Jeonnam 1 19 10-1 1 1 4 2-1 - - - - - - - - 8-35 1,117 1,211 Gyeongbuk - 37 23-6 2 1 5 4-4 1-1 - - - - - 6 2 51 1,641 1,881 Gyeongnam 1 57 36-3 1-10 5-2 - - 1 - - - - - 5 1 46 1,567 1,814 Jeju 1 22 18-1 - - 1 1 - - - - - - - - - - 8 2 9 252 317 Cum: Cumulative counts from 1st to current in a year * The reported data for year are provisional data but the data for years 2010, 2011, 2012, 2013 and 2014 are finalized data. According to surveillance data, the reported s may include all of the s such as confirmed, suspected, and asymptomatic carrier in the group. Syphilis, CJD/vCJD data on sentinel surveillance system changed to National Infectious Surveillance System as of December 30, 2010 average is mean value calculated by cumulative counts from 1st to current for 5 preceding years. 894
36th (8.30-9.5) Table 3. Reported s of national sentinel surveillance disease in the Republic of Korea, ending September 5, (36th Week) unit: no. of s/sentinels Viral hepatitis Sexually Transmitted s Hepatitis C Gonorrhea Chlamydia Genital herpes Condyloma acuminata Total 2.3 22.6 30.3 1.9 7.1 8.7 2.5 18.5 16.8 2.6 19.4 17.4 1.6 13.1 10.1 Cum: Cumulative counts from 1st to current in a year According to surveillance data, the reported s may include all of the s such as confirmed, suspected, and asymptomatic carrier in the group. average is mean value calculated by cumulative counts from 1st to current for 5 preceding years. 문의 : (043) 719-7168, 7178, 7166 주요통계이해하기 <Table 1> 은지난 5년간발생한법정감염병과 년해당주발생현황을비교한표로, 는 년해당주의신고건수를나타내며, 은 년 1주부터해당주까지의누계건수, 그리고 ly average 는지난 5년 (2010-2014 년 ) 해당주의신고건수와이전 2주, 이후 2주의신고건수 ( 총 25주 ) 평균으로계산된다. 그러므로 과 ly average 의신고건수를비교하면해당주단위시점과예년의신고수준을비교해볼수있다. Total no. of s by year 는지난 5년간해당감염병현황을나타내는확정통계이며연도별현황을비교해볼수있다. 예 ) 2014 년 12 주의 ly average(5 년간주평균 ) 는 2010 년부터 2014 년의 10 주부터 14 주까지의신고건수를 총 25 주로나눈값으로구해진다. * ly average(5 년주평균 )=(X1 + X2 + + X25)/25 10주 11주 12주 13주 14주 년 해당주 2014년 X1 X2 X3 X4 X5 2013년 X6 X7 X8 X9 X10 2012년 X11 X12 X13 X14 X15 2011년 X16 X17 X18 X19 X20 2010년 X21 X22 X23 X24 X25 <Table 2> 는 17 개시 도별로구분한법정감염병보고현황을보여주고있으며, 각감염병별로 Cum, average 와 Cum, 를비교해보면최근까지의누적신고건수에대한이전 5년동안해당주까지의평균신고건수와비교가가능하다. Cum, average 는지난 5년 (2010-2014 년 ) 동안의동기간신고누계평균으로계산된다. <Table 3> 은표본감시감염병에대한신고현황으로, 최근발생양상을신속하게파악하는데도움이된다. www.cdc.go.kr 895
PHWR Vol.8 No.37 발간등록번호 11-1351159-000002-03 Vol.8 N0.37 주간건강과질병, PHWR 은질병관리본부에서시행되는조사사업을통해생성된감시및연구자료를기반으로근거중심의건강및질병관련정보를제공하고자최선을다할것이며, 제공되는정보는질병관리본부의특정의사와는무관함을알립니다. 본간행물에서제공되는감염병통계는 감염병의예방및관리에관한법률 에의거, 국가감염병감시체계를통해신고된자료를기반으로집계된것으로집계된당해년도자료는의사환자단계에서신고된것이며확진결과시혹은다른병으로확인될경우수정될수있는잠정통계임을알립니다. 주간건강과질병, PHWR 은질병관리본부홈페이지를통해주간단위로게시되고있으며, 정기적구독을원하시는분은 oxsi@korea.kr로신청가능합니다. 이메일을통해보내지는본간행물의정기적구독요청시구독자의성명, 연락처, 직업및이메일주소가요구됨을알려드립니다. 주간건강과질병 발간관련문의 : oxsi@korea.kr/ 043-719-7166 창 발 간 : 2008 년 4 월 4 일 행 : 년 9 월 10 일 발행인 : 양병국 편집인 : 허영주 편집위원 : 윤승기, 박영준, 김윤아, 최영실, 김기순, 정경태, 최병선, 조신형, 조성범, 김봉조, 구수경, 김용우, 조은희, 박선희, 이주선, 최수영 편 집 : 질병관리본부감염병관리센터감염병감시과 충북청주시흥덕구오송읍오송생명 2 로 187 오송보건의료행정타운 ( 우 )28159 Tel. (043)719-7166, 7175 Fax. (043)719-7189